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«Aalborg Universitet Singing Dialogue : Music therapy with persons in advanced stages of dementia. Ridder, Hanne Mette Ochsner Publication date: ...»

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Aalborg Universitet

Singing Dialogue : Music therapy with persons in advanced stages of dementia.

Ridder, Hanne Mette Ochsner

Publication date:

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Link to publication from Aalborg University

Citation for published version (APA):

Ridder, H. M. O. (2003). Singing Dialogue : Music therapy with persons in advanced stages of dementia.: A case

study research design. Aalborg Universitet: Institut for Musik og Musikterapi, Aalborg Universitet.

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Downloaded from vbn.aau.dk on: October 17, 2016 Hanne Mette Ochsner Ridder Singing dialogue Music therapy with persons in advanced stages of dementia A case study research design PhD-thesis, 2003 Institut for Musik og Musikterapi Aalborg Universitet Revised edition 2005 Copyright c 2003 Hanne Mette Ochsner Ridder 2 Ridder: Singing Dialogue Abstract Persons suffering from primary degenerative dementia at later stages of the disease experience problems in perceiving environmental information and in expressing themselves in verbal language. This leads to difficulties in entering and maintaining dialogue. Failing possibilities of entering dialogue, psychosocial needs are not easily fulfilled, which leads to serious secondary symptoms of dementia. In this research the use of familiar songs in music therapy is suggested as a way of entering dialogue, where the communication is adjusted to the individual person.

A flexible mixed-method research design is carried out based on video observations, heart rate data, and observations from staff, external assessors, and the music therapist. One part of the research consists of 6 case studies where physiological data are used to validate observational data. Next part is a hermeneutic analysis of observations done by external assessors, leading to a catalogue of gestural responses and a coding and categorization of the qualities of these responses. In a third part examples from the case studies are analysed, using the categories that evolved in the previous part and describing various levels of communication.

The results show that; 1) Singing has a positive influence on the 6 participants, defined by degree of compliance, by changes in heart rate levels, and by various ways of taking part in the music therapy; 2) The six participants communicate responsively, and this communication can be recognised by a system of communicative signs, representing different levels of communication: emotional valence, receptive participation, sociality, active participation, communicative musicality, and dialogue. There exists a relationship between a balanced arousal level and communication at more intensive levels for all six participants; 3) In 5 of 6 concrete cases music therapy shows an influence on aspects in residential daily life, defined in a statistical significant decrease in heart rate levels pre/post therapy, for persons with severe dementia showing agitated behaviour.

The participants clearly profit from the music therapy sessions, and most important: these persons suffering from severe dementia are communicating and are able to be brought into a state where a communicative dialogue takes place. The songs offer a structure, which functions in focussing attention by mediating stability, as well as social and contextual cues.

Additionally the songs are used in regulating the arousal level of the participant towards environmental attention and a state most optimal for entering dialogue.

–  –  –

Acknowledgements This work has only been possible because a large number of people have given me support.

Support in very different ways, ranging from inspiration, challenge, information, trust, encourage and time.

I want to thank David Aldridge in his position as my supervisor. A supervisor is literally a person who is able to view matters from a broader sight. In German a supervisor is a Doktorvater (doctor father). Even though Germans traditionally would say ”Sie” to their Doktorvater, there is familiarity and confidence connected with the naming. In Danish a supervisor is a Vejleder (way-leader ), a guide and instructor. It is a person who knows the way and the direction to go, and is able to show which direction to go. To carry out research and writing a thesis is a privilege when one person, who manages being your supervisor as well as your Doktorvater and Vejleder, is at your side! Although there is a great distance between Witten-Herdecke (Germany) and Aalborg (Denmark), David Aldridge has been present in cyberspace, and always promptly answered my mails. The supervisions fully answered my questions, gave me lots of inspiration, information, encouragement, and new questions – and helped me in keeping my focus.

Thanks to Tony Wigram who arranged very giving, inspiring, and instructive courses for the PhD-students enrolled in the doctoral programme at Aalborg University. He invited leading authorities in the music therapy field to present at the courses, and made the basis for exciting and educational discussions at a very high level. Additionally, Tony Wigram organized presentations done by the PhD-students in the peer group in a professional and condent atmosphere, and the very constructive and challenging feedback – from Tony Wigram, the guest researchers, and the rest of the peer group – on our works in progress meant a lot to the quality of these respective works. He has made the PhD-courses a highlight in the study period and after each course I was loaded with new ideas, information, and perspectives.

Six persons, Mr A, Mr B, Mrs C, Mrs D, Mrs E, and Mrs F, spend 20 music therapy sessions with me and in this way contributed considerably to the clinical part of this research.

I still often think of these six, forceful personalities and I am grateful about what the gave to 4 Ridder: Singing Dialogue me without themselves being aware of it. I want to thank their relatives for the very positive attitude towards the research project and by letting the anonymized stories of their loved ones be part of this work.

For my colleagues, staff members on unit II, Plejehjemmet Caritas, the research project caused them extra work when filling out questionnaires and putting on equipment for heart rate measurements on the participants. I am thankful about our good collaboration, our talks, and the daily information about the participants. The knowledgecenter for ˚rhus county at A Caritas supplied me with important information. Inga I. Petersen supervised ethical issues concerning the participants, and principal, Birgit Mikkelsen, backed up the project from the very beginning.

My five music therapy colleagues: Bent Jensen, Niels Hannibal, Morten Højgaard, Sanne Storm and my teacher and Vejleder Inge Nygaard Pedersen spend many hours doing valuable analyses on the video clips, and contributed with important data to this work.

Christian Gold, the peer group expert in statistics, willingly discussed t-tests and statistical calculation with me. Tom and Gitte Duus, and Irene and Carsten Bro Brinkmeyer offered Bed & Breakfast when I needed to stay in Aalborg, and supported me with giving talks and very useful social research literature. Ulla Holck, whom I first time met when I started studying music therapy in 1985 and who finished her PhD in 2002, supported and encouraged me with comments on the text, talks and mails, and Lise Overgaard supported in a very special manner by pulling me out into the fresh air for long joggings.

When I write these lines, that are my last lines before this material goes to the printers, Christoph, my husband, is sitting at his computer working with layout details, while Christa Ridder, my mother-in-law is with the children. Together with Karen Ochsner, my mother, who spend hour after hour proofreading and trying to teach me a proper English, they have been the most supportive team to have around. Christoph’s IT-support and layout knowledge has been indispensable, and not least our dialogues.


By mere chance I saw a small advertisement in the local paper offering a job as music therapist.

I was attracted to the outer aspects of the job; it was close to my home, it was a part time job, and the conditions of appointments were all right. But!... the job was with old people.

Having worked with children and adolescents I had no experience in working as a music therapist with old people, and felt I had to start from scratch. Giving it a try I applied, and plunged headlong into the job. What I first saw were old patients with various deficits. Some had spent long periods of their lives on psychiatric wards, and were now offered a home here.

Others had led a “normal” life, but were struck by dementia and could no longer take care of themselves.

There were only 24 residents at the unit, and soon this group of patients or strangers became familiar to me. Not only did I learn their names, hear about their lives, and meet their relatives, but my perspective seemed to change, and I saw a person behind the deficits and saw the resources that were still there. I realised that my job as a music therapist was very privileged. The music often worked as a key that gave assess to pleasure, achievement, and expression within the person. I saw Mrs S close her eyes, smile, and sigh with contentment when she heard Placido Domingo sing, and Mr R accurately tapping the beat with his hand, when I played old songs from revues, and the tears in Mr G’s eyes when he joined in singing the song he had asked me to sing. Pleasure, achievement, and expression is described by the music therapist Trygve Aasgaard (2002, p. 219) as connected to Homo Ludens, a being who plays, Homo Faber, a being who creates/produces, and Homo Communicans, a being who communicates. – Aspects that again are connected to environmental characteristics in a culture of leisure, a culture of creativity, and in a culture of dialogues. Seeing these old people having fun, enjoying themselves, being creative and giving, expressing themselves and entering dialogue was seeing the person behind the deficits.

It was a privilege too when 5 years later I had the possibility to carry out research in this field. It was clear to me that my focus would be on the use of familiar, pre-composed songs in individual music therapy, although in my clinical job I worked in various ways with music. I see the songs as a key to the person, and a key to enter dialogue with persons who might have lost the ability to use words in spoken language and the ability to play on music instruments.

Actively playing with instruments and improvising seems to be the most described form of music therapy.

This work deals with a group of “clients” or “patients” with severe symptoms of dementia, and the participants described in the study suffer from dementia in advanced stages and are living in a special gerontopsychiatric care unit. When I refer to texts I might repeat the authors’ way of naming this group of people as patients, clients, or subjects, but otherwise I name them as persons with dementia or as the participants.

Readers who have the courage to take a plunge into all these words are most likely professionals in the health care sector, interested in a non-pharmacological approach to dementia care, therapists with an interest in the clinical application of music therapy with a client group close to the one described here, and/or researchers with an interest in flexible research design strategies.

The research is carried out in close collaboration with Care Unit II, the Nursing home Caritas, the Knowledge Centre on dementia in ˚rhus County, and Aalborg University, and A with approval from relatives, from the ethical committee in ˚rhus County, and the Danish A register inspection.

6 Ridder: Singing Dialogue Overview of the thesis The first three chapters contain a theoretical introduction and presentation of terms and understandings relevant to the research. Chapter 4 describes the research methodology, and chapter 5 the clinical background. The next three chapters imply different research strategies and give different perspectives on what I want to present as the essence of this kind of music therapy work, approaching this essence with different means. Chapter 6 consists of 6 case studies, chapter 7 of a hermeneutic analysis (using the computer software ATLAS.ti) of eight short video clips with observations done by external assessors, and chapter 8 is a synthesis of chapter 6 and 7, using the coding tool formulated in chapter 7 on examples from the case studies in chapter 6. Chapter 9 is a conclusion of the work.

Each section or chapter is completed with a short summary. The index on the very last pages facilitates the search for certain topics in the material, and at page 354 are listed the abbreviations used in the text.


–  –  –

Music therapy and dementia “Neurology’s favourite word is “deficit”, denoting an impairment or incapacity of neurological function: loss of speech, loss of language, loss of memory, loss of vision, loss of dexterity, loss of identity and a myriad other lacks and losses of specific functions (or faculties).” (Sacks 1985, p. 1)

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